U.S. Surgical Specialist Practice Patterns in the

Management of Gastroesophageal Reflux Disease

Gordon H. Sun, MD, MS; Michael S. Broder, MD, MSHS

Partnership for Health Analytic Research, LLC, Beverly Hills, CA

100 patients unweighted; 1,582,391 weighted

All adult patients

Typical patient was middle-aged white female

Two-thirds of patients were seen by otolaryngologists

Nearly one-third of patients received some sort of lifestyle modification

intervention, most commonly diet/nutrition counseling

Slightly more than 10% underwent upper gastrointestinal endoscopy

One-third received a new prescription for GERD (PPI or H2RA)

Significant differences in practices were found between otolaryngologists

and general surgeons across several interventions

Otolaryngologists prescribed new GERD medications (47.8% vs. 2.7%,

p<.001), including PPIs (41.8% vs. 0.9%, p<.001), more frequently

General surgeons provided health education more frequently (56.0% vs.

16.4%, p=.048)

General surgeons also conducted upper gastrointestinal endoscopy more

often (25.4% vs. 3.2%, p=.0015)

1. El-Serag HB, Sweet S, Winchester CC, Dent J. Gut. Jul 13 2013 [Epub ahead of print].

2. Friedenberg FK, Hanlon A, Vanar V, et al. Dig Dis Sci. Jul 2010;55(7):1911-1917.

3. Lacy BE, Crowell MD, Riesett RP, Mitchell A. J Clin Gastroenterol. Jul 2005;39(6):489-494.

4. Wong WM, Lim P, Wong BC. J Gastroenterol Hepatol. Sep 2004;19 Suppl 3:S54-60.

OBJECTIVE TABLE RESULTS

METHODS

Retrospective cohort study of the 2006-2010 National Ambulatory

Medical Care Survey (NAMCS)

Study cohort comprised new patients diagnosed with GERD in US

otolaryngology and general surgery outpatient clinics

International Classification of Diseases, Ninth Revision,

Clinical Modification (ICD-9-CM) diagnostic codes 530.11,

530.81, and 787.1

Descriptive analysis of baseline demographic and medical

characteristics of eligible patients

Patient age, sex, race, insurance status, and number of

chronic conditions

Geographic area of visit

Surgeon specialty

Nationally representative estimates obtained by survey

weights

Comparison of practice patterns within each clinical setting using chi-

squared tests

Use of diagnostic upper gastrointestinal endoscopy:

esophagoscopy or esophagogastroduodenoscopy (EGD),

identified using ICD-9-CM procedure codes 42.23, 42.24,

45.13, 45.14, and 45.16

Lifestyle modification counseling: diet/nutrition, stress

management, tobacco use/exposure, and weight reduction

New prescriptions for proton pump inhibitors (PPI) and H2-

receptor antagonists (H2RA), identified using Multum

Lexicon Plus® (Cerner Multum, Inc., Denver, CO) codes

Stata 12.1 (StataCorp LP; College Station, TX) for all analyses

Gastroesophageal reflux disease (GERD) is the most common

gastrointestinal disorder diagnosed in the outpatient setting in the

United States, with a prevalence of 18.1%-27.8%1

Older data suggest differences in diagnostic and treatment patterns for

GERD across varying specialties2-4

This study examined differences in diagnostic practices for new

patients with GERD in ambulatory surgical specialist settings

Otolaryngologists accounted for nearly two-thirds of new GERD patient

visits to US surgeons

Significant differences in GERD diagnostic practices exist between

otolaryngologists and general surgeons

CONCLUSIONS

KEY REFERENCES

Patient Characteristic or Intervention Value Age, years (mean ± standard deviation) 52.4 ± 1.8

Female sex 67.3%

White race 85.7%

Number of concurrent chronic diseasesa

None

1

≥2

54.6%

19.1%

25.1%

Surgical specialist

Otolaryngologist

General surgeon

65.4%

34.6%

Patients receiving any lifestyle counseling

Diet/nutrition

Stress management

Tobacco use/exposure

Weight reduction

30.1%

28.5%

None reported

7.3%

6.3%

Patients undergoing upper GI endoscopy 10.9%

Patients receiving any new GERD prescriptions

PPI

H2RA

32.1%

27.6%

5.7%

This poster was presented at the 2014 AcademyHealth Annual Research Meeting, June 10, 2014, San Diego, CA, USA.

POLICY IMPLICATIONS

Diagnostic practice variation may reflect underlying differences in surgical

training and scope of practice, as well as differing expectations for

patients visiting a given specialty

Further research is required to explore these issues, as well as potential

differences in treatment patterns outside of the ambulatory clinic setting

Legend: GI = gastrointestinal, H2RA = histamine-2 receptor antagonist, PPI = proton pump inhibitor. a Approximately 1.3% of patients had no available data on the number of chronic diseases.

FIGURE

0 10 20 30 40 50 60

Lifestyle Modification

Esophagoscopy

New PPI

New H2RA

% of Patients Receiving Intervention

General Surgery

Otolaryngology